According to a recent University of Massachusetts Boston report, Asian Americans face significant health disparities but customary health survey methods are not reaching these populations. This leads to a complex problem where the diverse health needs of Asian Americans are often overlooked, and funding for health programs suffers.
The report – which evaluated publicly available sources of data on Asian Americans in Massachusetts – makes several important recommendations for improving collection of data. OMH spoke with lead author Carolyn Wong of the Institute for Asian American Studies (IAAS) at the University of Massachusetts Boston about the report and what researchers and funders throughout the nation can take from the findings.
OMH: What are the major challenges in tracking and mining health data concerning Asian American populations?
Wong: I think a few factors come into strong play. While Asian Americans are a small proportion of the population in many states, it is not widely known that if we count Asian Americans as an aggregate category – including its component parts of many different ethnicities – they are the fastest growing racial group in the U.S., with their numbers increasing at a rate just a bit greater but comparable to that of Latinos, according to the 2010 census. Asian Americans face a problem of invisibility in disparities research, but it will not take long for this to change.
Another challenge is the popular image disseminated by the mass media that Asian Americans are all immigrant "success stories" and therefore face no significant problems. This is simply wrong. As a result, their distinctive health problems can easily be overlooked or misunderstood. The Asian American population is not homogenous. In fact, people of Korean, Vietnamese, Chinese, Asian Indian, Cambodian, Hmong, Japanese, Thai, Vietnamese and many other ancestries are in many ways quite different.
Also, Asian Americans present a complicated social-economic profile. In Boston, for example, Asians have the highest poverty rates of any racial or ethnic group in the city. Many Chinese and Vietnamese live in low-income neighborhoods. At the same time Massachusetts draws many professionals and college students of Asian descent and nationality. Some of the towns surrounding Boston have concentrations of economically impoverished residents, such as Cambodians in Lowell, and others have quite a few affluent professionals. Success stories of the professionals often garner more publicity than problems faced by those living in poverty or in isolation – people often considered "outsiders" on the social margins of the city.
With such a diverse population, yes, it is hard to reach out to all the sub-populations, especially in the many languages they speak. And any reliable method of tracking the health of these diverse populations has to avoid lumping together all the diverse ethnicities and over-generalizing patterns that could be observed by looking at one ethnic group or households in one residential area. Otherwise information tracking health is misleading.
OMH: Is there also a language barrier that adds to the problem?
Wong: Yes. The Massachusetts Department of Public Health administers a survey of the health of residents in the state and there are some evolving strategies to target communities where persons of Asian American ethnicities live in relatively greater numbers than in the state at large. However, the strategies do not yet include conducting the phone interviews in any of the major Asian languages spoken. This biases the data toward English speaking respondents of Asian ethnicities, who are likely to have somewhat different health challenges than those who have limited English proficiency or are mono-lingual in an Asian language.
OMH: You state that collecting data on Asian American populations in cost-prohibitive. Why? What can public and private research funders do to help solve this problem?
Wong: Since conducting surveys in Asian languages requires translators, the costs of employing them and training them is often not factored into budgets for health surveys. There are now improved techniques to try to identify the ethnicity of persons on phone lists, using surnames and given names, and it is possible to thus target Asian respondents by creating a list of these names to call. But still translators have to be on hand to interview the respondent if he or she chooses to be interviewed in an Asian language. To draw attention to these issues and secure the funds to conduct surveys and other forms of research, we recommend forming partnerships between private and public entities, such as health agencies, academic institutions, health insurers and funders interested in health research.
OMH: You mention that sample sizes of Asian American patients in most statewide health surveys are typically too small. Is that a trend nationally as well? Are there organizations or public agencies in areas with larger Asian American populations that might be able to offer lessons learned?
Wong: Asian Americans in most states make up less than 5 percent of population. In a conventional household survey where household members are called by phone and asked to participate, the households are randomly selected across the state. Then the number of Asian Americans included will be roughly proportionate to their population share. Few surveys recruit a large enough overall sample to obtain more than a hundred or perhaps a few hundred Asian Americans. Once you break out the distinctive ethnic groups, the sample size for each will be too small to draw reliable statistical inferences. Again, in California, there are encouraging models that public health professionals can learn from. The California Health Information Survey, which is funded by a network of public and private organizations, uses both traditional methods to contact potential respondents by landlines and cellphones, but also uses a supplemental list of Korean and Vietnamese surnames to ensure representation of these ethnic groups in the overall sample.
OMH: What additional conclusions from the study are important for public health and health care professionals, policymakers and/or funders to take away?
Wong: One of our main recommendations is that academic researchers seeking health data on Asian Americans find innovative and flexible ways to partner with community-based organizations, especially those working directly with clients or members in low-wage immigrant communities. The community-based organizations can help researchers gain access to populations that are hard to reach and pose research questions or suggest hypotheses that may not come to mind to researchers coming from the outside.
In addition, we recommend that hospitals and other providers provide better training to their staff to increase understanding of the cultural backgrounds of their diverse patient populations. They will not be able to effectively gather data on the patients unless they are attune to their cultural practices, not just language, but cultural idioms and concepts of health.